Single serum progesterone as a screen for ectopic pregnancy: Exchanging specificity and sensitivity to obtain optimal test performance

M. L. McCord, D. Muram, J. E. Buster, Kristopher Arheart, T. G. Stovall, S. A. Carson

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Objective: To investigate the diagnostic accuracy of screening serum P in diagnosis of ectopic pregnancy (EP) and to identify a cutoff value that provides the best compromise between test sensitivity and specificity. Design: Retrospective analysis. Setting: University hospital. Interventions: Observation only. Patients: First trimester pregnant women at risk for EP. Main Outcome Measure: Single P measurements were obtained from 3,674 pregnancies with outcomes defined as EP, viable intrauterine pregnancy (IUP), and spontaneous abortion (SAB). Diagnostic accuracy of the test was analyzed by generating receiver operating characteristic (ROC) curves, which quantify the ability of the test to distinguish EP and SAB from IUP. Results: Diagnostic accuracy for EP versus IUP was 88.7% ± 0.1% (mean ± SEM); for SAB versus IUP, 93.8% ± 0.4%; and for SAB + EP versus IUP, 92.8% ± 0.4%. Diagnostic accuracy for SAB versus EP was only 39.4% ± 0.2%. In the interval of 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L), P missed 5.3% of the EPs and incorrectly included 84.3% of the viable IUPs; in the interval of 20.0 to 24.9 ng/mL (63.6 to 79.2 nmol/L), sensitivity improved in that only 3.5% of the EPs were missed but 88.8% of viable IUPs were included incorrectly. A cutoff value of ≤ 17.5 ng/mL (55.7 nmol/L), the median point of the 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L) interval, missed only 35 of 423 (8.3%) total EPs in the study. Conclusion: Analysis of ROC curves demonstrates that single serum P has high diagnostic accuracy for differentiating accidents of pregnancy (SAB and EP) from viable IUP, both individually (SAB versus IUP and EP versus IUP) and collectively (SAB + EP versus IUP); it cannot efficiently discriminate SAB versus EP. We conclude that for P ≤ 17.5 ng/mL (55.7 nmol/L), patients thought to be at risk for EP may be followed reasonably without ultrasound or further invasive diagnostic studies.

Original languageEnglish
Pages (from-to)513-516
Number of pages4
JournalFertility and Sterility
Volume66
Issue number4
StatePublished - Sep 30 1996
Externally publishedYes

Fingerprint

Ectopic Pregnancy
Progesterone
Spontaneous Abortion
Sensitivity and Specificity
Pregnancy
Serum
ROC Curve
First Pregnancy Trimester
Pregnancy Outcome
Routine Diagnostic Tests
Accidents
Pregnant Women
Observation
Outcome Assessment (Health Care)

Keywords

  • diagnosis
  • Ectopic pregnancy
  • progesterone
  • ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

McCord, M. L., Muram, D., Buster, J. E., Arheart, K., Stovall, T. G., & Carson, S. A. (1996). Single serum progesterone as a screen for ectopic pregnancy: Exchanging specificity and sensitivity to obtain optimal test performance. Fertility and Sterility, 66(4), 513-516.

Single serum progesterone as a screen for ectopic pregnancy : Exchanging specificity and sensitivity to obtain optimal test performance. / McCord, M. L.; Muram, D.; Buster, J. E.; Arheart, Kristopher; Stovall, T. G.; Carson, S. A.

In: Fertility and Sterility, Vol. 66, No. 4, 30.09.1996, p. 513-516.

Research output: Contribution to journalArticle

McCord, ML, Muram, D, Buster, JE, Arheart, K, Stovall, TG & Carson, SA 1996, 'Single serum progesterone as a screen for ectopic pregnancy: Exchanging specificity and sensitivity to obtain optimal test performance', Fertility and Sterility, vol. 66, no. 4, pp. 513-516.
McCord, M. L. ; Muram, D. ; Buster, J. E. ; Arheart, Kristopher ; Stovall, T. G. ; Carson, S. A. / Single serum progesterone as a screen for ectopic pregnancy : Exchanging specificity and sensitivity to obtain optimal test performance. In: Fertility and Sterility. 1996 ; Vol. 66, No. 4. pp. 513-516.
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abstract = "Objective: To investigate the diagnostic accuracy of screening serum P in diagnosis of ectopic pregnancy (EP) and to identify a cutoff value that provides the best compromise between test sensitivity and specificity. Design: Retrospective analysis. Setting: University hospital. Interventions: Observation only. Patients: First trimester pregnant women at risk for EP. Main Outcome Measure: Single P measurements were obtained from 3,674 pregnancies with outcomes defined as EP, viable intrauterine pregnancy (IUP), and spontaneous abortion (SAB). Diagnostic accuracy of the test was analyzed by generating receiver operating characteristic (ROC) curves, which quantify the ability of the test to distinguish EP and SAB from IUP. Results: Diagnostic accuracy for EP versus IUP was 88.7{\%} ± 0.1{\%} (mean ± SEM); for SAB versus IUP, 93.8{\%} ± 0.4{\%}; and for SAB + EP versus IUP, 92.8{\%} ± 0.4{\%}. Diagnostic accuracy for SAB versus EP was only 39.4{\%} ± 0.2{\%}. In the interval of 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L), P missed 5.3{\%} of the EPs and incorrectly included 84.3{\%} of the viable IUPs; in the interval of 20.0 to 24.9 ng/mL (63.6 to 79.2 nmol/L), sensitivity improved in that only 3.5{\%} of the EPs were missed but 88.8{\%} of viable IUPs were included incorrectly. A cutoff value of ≤ 17.5 ng/mL (55.7 nmol/L), the median point of the 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L) interval, missed only 35 of 423 (8.3{\%}) total EPs in the study. Conclusion: Analysis of ROC curves demonstrates that single serum P has high diagnostic accuracy for differentiating accidents of pregnancy (SAB and EP) from viable IUP, both individually (SAB versus IUP and EP versus IUP) and collectively (SAB + EP versus IUP); it cannot efficiently discriminate SAB versus EP. We conclude that for P ≤ 17.5 ng/mL (55.7 nmol/L), patients thought to be at risk for EP may be followed reasonably without ultrasound or further invasive diagnostic studies.",
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T1 - Single serum progesterone as a screen for ectopic pregnancy

T2 - Exchanging specificity and sensitivity to obtain optimal test performance

AU - McCord, M. L.

AU - Muram, D.

AU - Buster, J. E.

AU - Arheart, Kristopher

AU - Stovall, T. G.

AU - Carson, S. A.

PY - 1996/9/30

Y1 - 1996/9/30

N2 - Objective: To investigate the diagnostic accuracy of screening serum P in diagnosis of ectopic pregnancy (EP) and to identify a cutoff value that provides the best compromise between test sensitivity and specificity. Design: Retrospective analysis. Setting: University hospital. Interventions: Observation only. Patients: First trimester pregnant women at risk for EP. Main Outcome Measure: Single P measurements were obtained from 3,674 pregnancies with outcomes defined as EP, viable intrauterine pregnancy (IUP), and spontaneous abortion (SAB). Diagnostic accuracy of the test was analyzed by generating receiver operating characteristic (ROC) curves, which quantify the ability of the test to distinguish EP and SAB from IUP. Results: Diagnostic accuracy for EP versus IUP was 88.7% ± 0.1% (mean ± SEM); for SAB versus IUP, 93.8% ± 0.4%; and for SAB + EP versus IUP, 92.8% ± 0.4%. Diagnostic accuracy for SAB versus EP was only 39.4% ± 0.2%. In the interval of 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L), P missed 5.3% of the EPs and incorrectly included 84.3% of the viable IUPs; in the interval of 20.0 to 24.9 ng/mL (63.6 to 79.2 nmol/L), sensitivity improved in that only 3.5% of the EPs were missed but 88.8% of viable IUPs were included incorrectly. A cutoff value of ≤ 17.5 ng/mL (55.7 nmol/L), the median point of the 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L) interval, missed only 35 of 423 (8.3%) total EPs in the study. Conclusion: Analysis of ROC curves demonstrates that single serum P has high diagnostic accuracy for differentiating accidents of pregnancy (SAB and EP) from viable IUP, both individually (SAB versus IUP and EP versus IUP) and collectively (SAB + EP versus IUP); it cannot efficiently discriminate SAB versus EP. We conclude that for P ≤ 17.5 ng/mL (55.7 nmol/L), patients thought to be at risk for EP may be followed reasonably without ultrasound or further invasive diagnostic studies.

AB - Objective: To investigate the diagnostic accuracy of screening serum P in diagnosis of ectopic pregnancy (EP) and to identify a cutoff value that provides the best compromise between test sensitivity and specificity. Design: Retrospective analysis. Setting: University hospital. Interventions: Observation only. Patients: First trimester pregnant women at risk for EP. Main Outcome Measure: Single P measurements were obtained from 3,674 pregnancies with outcomes defined as EP, viable intrauterine pregnancy (IUP), and spontaneous abortion (SAB). Diagnostic accuracy of the test was analyzed by generating receiver operating characteristic (ROC) curves, which quantify the ability of the test to distinguish EP and SAB from IUP. Results: Diagnostic accuracy for EP versus IUP was 88.7% ± 0.1% (mean ± SEM); for SAB versus IUP, 93.8% ± 0.4%; and for SAB + EP versus IUP, 92.8% ± 0.4%. Diagnostic accuracy for SAB versus EP was only 39.4% ± 0.2%. In the interval of 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L), P missed 5.3% of the EPs and incorrectly included 84.3% of the viable IUPs; in the interval of 20.0 to 24.9 ng/mL (63.6 to 79.2 nmol/L), sensitivity improved in that only 3.5% of the EPs were missed but 88.8% of viable IUPs were included incorrectly. A cutoff value of ≤ 17.5 ng/mL (55.7 nmol/L), the median point of the 15.0 to 19.9 ng/mL (47.7 to 63.3 nmol/L) interval, missed only 35 of 423 (8.3%) total EPs in the study. Conclusion: Analysis of ROC curves demonstrates that single serum P has high diagnostic accuracy for differentiating accidents of pregnancy (SAB and EP) from viable IUP, both individually (SAB versus IUP and EP versus IUP) and collectively (SAB + EP versus IUP); it cannot efficiently discriminate SAB versus EP. We conclude that for P ≤ 17.5 ng/mL (55.7 nmol/L), patients thought to be at risk for EP may be followed reasonably without ultrasound or further invasive diagnostic studies.

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KW - Ectopic pregnancy

KW - progesterone

KW - ultrasound

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